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Journals
Year of Publication
1.  Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture 
Asian Spine Journal  2010;4(2):102-108.
Study Design
A retrospective study.
Purpose
To compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty.
Overview of Literature
Kyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced.
Methods
Between 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction.
Results
All patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0° in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5° after 3 months.
Conclusions
Lordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.
doi:10.4184/asj.2010.4.2.102
PMCID: PMC2996621  PMID: 21165313
Osteoporotic vertebral compression fracture; Lordoplasty; Vertebroplasty
2.  Reliability and Validity of Thoracolumbar Injury Classification and Severity Score (TLICS) 
Asian Spine Journal  2010;4(2):109-117.
Study Design
A new classification system for throacolumbar spine injury, Thoracolumbar Injury Classification and Severity Score (TLICS) was evaluated retrospectively.
Purpose
To evaluate intrarater and interrater reliability of newly proposed TLICS schemes and to estimate validity of TLICS's final treatment recommendation.
Overview of Literature
Despite numerous literature about thoracolumbar spine injury classifications, there is no consensus regarding the optimal system.
Methods
Using plain radiographs, computed tomography scanning, magnetic resonance imaging, and medical records, 3 clssifiers, consisting of 2 spine surgeons and 1 senior orthopaedic surgery resident, reviewed 114 clinical thoracolumbar spine injury cases retrospectively to classify and calculate injury severity score according to TLICS. This process were repeated on 4 weeks intervals and the scores were then compared with type of treatment that patient ultimately received.
Results
The intrarater reliability of TLICS was substantial agreement on total score and injury morphology, almost perfect agreement on integrity of the posterior ligament complex (PLC) and neurologic status. The interrater reliability was substantial agreement on injury morphology and integrity of the PLC, moderate agreement on total score, almost perfect agreement on neurologic status. The TLICS schems exhibited satisfactory overall validity in terms of clinical decision making.
Conclusions
The TLICS was demonstrated acceptable intrarater and interrater reliability and satisfactory validity in terms of treatment recommendation.
doi:10.4184/asj.2010.4.2.109
PMCID: PMC2996622  PMID: 21165314
Thoracolumbar spine injury; Classification; TLICS; Reliability; Validity
3.  Delayed Spinal Epidural Hematoma after En Block Spondylectomy for Vertebral Ewing's Sarcoma 
Asian Spine Journal  2010;4(2):118-122.
We report here on a case of a 23-year-old male who received en block spondylectomy for a vertebral Ewing's sarcoma at our hospital. Nine days after surgery, he presented with severe back pain and motor weakness of the lower extremities. Based on the physical examination and the computed tomography scan, he was diagnosed with acute cauda equina syndrome that was caused by compression from an epidural hematoma. His neurological functions recovered after emergency evacuation of the hematoma. This case showed that extensive surgery for a malignant vertebral tumor has a potential risk of delayed epidural hematoma and acute cauda equina syndrome and this should be treated with emergency evacuation.
doi:10.4184/asj.2010.4.2.118
PMCID: PMC2996623  PMID: 21165315
Epidural hematoma; Ewing's sarcoma; Spine; En block spondylectomy
4.  The Acute Calcific Prevertebral Tendinitis: Report of Two Cases 
Asian Spine Journal  2010;4(2):123-127.
Acute calcific prevertebral tendinitis, which is also known as retropharyngeal calcific tendinitis and longus colli tendinitis, is an under-recognized cause of acute cervical pain produced by an inflammation of the longus colli muscle. The typical characteristics of this entity are calcifications at the superior insertion of the longus colli tendons at the C1-C2 level and fluid collection in the retropharyngeal space. The differential diagnosis includes a retropharyngeal abscess, infectious spondylitis or traumatic injury. Knowledge of the clinical and imaging findings can prevent a misdiagnosis and inappropriate attempts at surgical drainage.
doi:10.4184/asj.2010.4.2.123
PMCID: PMC2996624  PMID: 21165316
Longus colli; Retropharynx; Calcific tendinitis
5.  Open Reduction without Fusion of Bilateral Jumped Lumbosacral Facet Dislocation Associated with Symphysis Pubis Separation and Cauda Equina Syndrome: Case Report 
Asian Spine Journal  2010;4(2):128-131.
This paper reports a rare case of a lumbosacral dislocation associated with symphysis pubis separation and cauda equina syndrome. A 39-year-old male who diagnosed traumatic lumbosacral dislocation underwent an open reduction without fusion. After an open reduction and internal fixation of a symphysis pubis separation, a missed lumbosacral dislocation was diagnosed and an open reduction was performed without fusion. Due to the symphysis pubis separation, the patient was not allowed weight bearing for 3 months, which then began from wheel chair ambulation. At the 6-month follow up evaluation, there was no back pain but the patient reported mild S1 nerve root sensory symptoms. Lumbosacral dislocation is common in high energy polytrauma patients and can be misdiagnosed. However, prompt reduction without fusion is a good alternative treatment.
doi:10.4184/asj.2010.4.2.128
PMCID: PMC2996625  PMID: 21165317
Lumbosacral facet dislocation; Polyradiculopathy; Open reduction; Non-fusion
6.  Surgical Treatment of Benign Fibrous Histiocytoma as a Form of Intraspinal Extradural Tumor at Lumbar Spine 
Asian Spine Journal  2010;4(2):132-135.
A benign fibrous histiocytoma (BFH) is one of the fibrohistiocytic groups of soft-tissue tumors for which spinal involvement is extremely rare. To the best of our knowledge, most spine-originating BFHs are bone tumors. We report the first case of BFH occurring in the intraspinal extradural space on the lumbar spine. A 66-year-old female presented with severe claudication symptom. The preoperative magnetic resonance images showed a huge intraspinal, extradural, thecal-sac-compressing soft-tissue tumor that extended along the right L5 root to the neural foramen. The tumor was a relatively well-marginated, inhomogeneous soft-tissue mass with some fluid-containing cystic portions that were well enhanced by the gadolinium contrast dye. After a total facectectomy, the tumor was removed completely. The patient had a good neurological recovery without complications, and no recurrence was noted at the 6-month follow-up.
doi:10.4184/asj.2010.4.2.132
PMCID: PMC2996626  PMID: 21165318
Histiocytoma; Benign fibrous; Soft tissue neoplasms; Lumbar vertebrae
7.  Postoperative Meningitis in Patients with Cervical Cord Tumor: A Case Report 
Asian Spine Journal  2010;4(2):136-140.
Postoperative meningitis after spinal surgery is a rare complication that can result in a life-threatening condition. Linezolid (LZD) is an oxazolidinone which has been approved in Japan for infections caused by methicillin-resistant Staphylococcus aureus. The authors encountered a case of postoperative meningitis with cerebrospinal fluid leakage (liquorrhoea) that occurred after resection of a cervical cord tumor. The infection was caused by methicillin-resistant Staphylococcus epidermidis(MRSE). Debridement and suture of the dura matter was carried out. LZD was given intravenously. The infection was cured without any sequelae. Based on this result, we concluded that LZD might be considered as one of the first choices for the treatment of postsurgical meningitis caused by MRSE.
doi:10.4184/asj.2010.4.2.136
PMCID: PMC2996627  PMID: 21165319
CSF leakage; Postoperative meningitis; Surgical site infection; Methicillin-resistant Staphylococcus epidermidis; Linezolid
8.  Thirty Years after Paul Randall Harrington (September 27, 1911-November 29, 1980) 
Asian Spine Journal  2010;4(2):141-142.
doi:10.4184/asj.2010.4.2.141
PMCID: PMC2996628  PMID: 21165320
9.  Asymptomatic Cervical or Thoracic Lesions in Elderly Patients who Have Undergone Decompressive Lumbar Surgery for Stenosis 
Asian Spine Journal  2010;4(2):65-70.
Study Design
A retrospective study.
Purpose
To evaluate the prevalence and risk factors of asymptomatic cervical or thoracic lesions in elderly patients who have undergone surgery for lumbar spinal stenosis.
Overview of Literature
Concurrent multiple spinal lesions have been reported in many studies with a varied prevalence, and described the characteristics of the disease and its treatment options. However, the cervical or thoracic lesions without apparent symptoms in patients with symptomatic lumbar stenosis had not been evaluated.
Methods
A total of 101 elderly patients (aged 65 or more), who had undergone surgery for lumbar spinal stenosis from January 2005 to December 2005, were enrolled in this study. All patients underwent lumbar magnetic resonance imaging (MRI) along with T2-weighted cervical and thoracic sagittal MRI prior to surgery. The concurrent cervical or thoracic lesions were classified according to the disease entity, and the severity of the lesions was graded from grade 0 (no lesion) to grade 4 (any lesion compressing the cord with a signal change). The prevalence of concurrent cervical and thoracic lesions was then analyzed. In addition, the risk factors for the development of concurrent lesions were evaluated, and the risk factors affecting the severity of the concurrent lesion were analyzed individually.
Results
Seventy-seven (76.2%) and 30 (29.7%) patients had a concurrent cervical and thoracic lesion, respectively. Twenty-six patients (25.7%) had both a cervical and thoracic lesion. There was a positive correlation between the symptom duration of lumbar stenosis and the prevalence of both cervical (p = 0.044) and thoracic (p = 0.022) lesions.
Conclusions
The incidence of asymptomatic cervical or thoracic lesions is apparently high in elderly patients who have undergone surgery for lumbar spinal stenosis, particularly in those with longer symptom duration. This highlights the need for a preoperative evaluation of the cervical and thoracic spine in these patients.
doi:10.4184/asj.2010.4.2.65
PMCID: PMC2996629  PMID: 21165307
Asymptomatic; Concurrent; Cervical; Thoracic; Lumbar stenosis; Aged
10.  Antibiotic Microbial Prophylaxis for Spinal Surgery: Comparison between 48 and 72-Hour AMP Protocols 
Asian Spine Journal  2010;4(2):71-76.
Study Design
This is a prospective randomized cohort study.
Purpose
We intended to evaluate the efficacy of a 48 hour antibiotic microbial prophylaxis (AMP) protocol as compared with a 72 hour AMP protocol.
Overview of Literature
The current guideline for the prevention of surgical site infection (SSI) suggests the AMP should not exceed 24 hours after clean surgery like spinal surgery. But there exist some confusion in real clinical practice about the duration of postoperative antibiotic administration because the evidence of the guideline was not robust.
Methods
The subjects were 548 patients who underwent spinal surgery at our department from April 2007 to December 2008. The patients were classified into two groups according to the prophylaxis protocol: group A, for which AMP was employed for 72 hours postoperatively and group B, for which AMP was employed for 48 hours postoperatively. Five hundred two patients out of 548 patients were followed until 6 months postoperatively. The incidence of SSI in the two groups was analyzed.
Results
The overall infection rate was 0.8%. There was no significant difference in infection rate between the two groups. The overall infection rate for the patients who underwent instrumented fusion was 0.9%. There was no significant difference in the infection rate between the patients of the two groups who underwent instrumented fusion.
Conclusions
AMP for 48 hours is as efficient as AMP for 72 hours.
doi:10.4184/asj.2010.4.2.71
PMCID: PMC2996630  PMID: 21165308
Spine; Surgical site infection; Anti-bacterial agents
11.  Relationship between New Osteoporotic Vertebral Fracture and Instrumented Lumbar Arthrodesis 
Asian Spine Journal  2010;4(2):77-81.
Study Design
Retrospective study.
Purpose
To evaluate the relationship between a new osteoporotic vertebral fracture and instrumented lumbar arthrodesis.
Overview of Literature
In contrast to the growing recognition of the importance of adjacent segment disease after lumbar arthrodesis, relatively little attention has been paid to the relationship between osteoporotic vertebral fractures and instrumented lumbar arthrodesis.
Methods
Twenty five patients with a thoracolumbar vertebral fracture following instrumented arthrodesis for degenerative lumbar disorders (study group) were investigated. The influence of instrumented lumbar arthrodesis was examined by comparing the bone mineral density (BMD) of the femoral neck in the study group with that of 28 patients (control group) who had sustained a simple osteoporotic vertebral fracture. The fracture after instrumented arthrodesis was diagnosed at a mean 47 months (range, 7 to 100 months) after the surgery.
Results
There was a relatively better BMD in the study group, 0.67 ± 0.12 g/cm2 compared to the control group, 0.60 ± 0.13 g/cm2 (p = 0.013). The level of back pain improved from a mean of 7.5 ± 1.0 at the time of the fracture to a mean of 4.9 ± 2.0 at 1 year after the fracture (p = 0.001). However, 12 (48%) patients complained of severe back pain 1 year after the fracture. There was negative correlation between the BMD of the femoral neck and back pain at the last follow up (r = - 0.455, p = 0.022).
Conclusions
Osteoporotic vertebral fractures after instrumented arthrodesis contribute to the aggravation of back pain and the final outcome of degenerative lumbar disorders. Therefore, it is important to examine the possibility of new osteoporotic vertebral fractures for new-onset back pain after lumbar instrumented arthrodesis.
doi:10.4184/asj.2010.4.2.77
PMCID: PMC2996631  PMID: 21165309
Lumbar spine; Vertebral fracture; Osteoporosis; Instrumented arthrodesis
12.  Comparison between Operated Muscular Dystrophy and Spinal Muscular Atrophy Patients in terms of Radiological, Pulmonary and Functional Outcomes 
Asian Spine Journal  2010;4(2):82-88.
Study Design
Retrospective comparative study.
Purpose
To study and compare the surgical outcomes of muscular dystrophy (MD) and spinal muscle atrophy (SMA).
Overview of Literature
There are few reports that have evaluated and compared the surgical outcomes of MD and SMA patients.
Methods
The patients (n = 35) were divided into two groups: a MD group with 24 patients and a SMA group with 11 patients. The average follow-up period was 21 months. All patients were operated for scoliosis correction using posterior instrumentation and fusion. In the immediate postoperative period, all efforts were made to reduce the pulmonary complications using non-invasive positive pressure ventilation and a coughing assist devices. The patients were evaluated by radiograph in terms of the Cobb's angle, pelvic obliquity, T1 translation, thoracic kyphosis and lumbar lordosis. The pulmonary function and self-image satisfaction were also assessed.
Results
There was a lower correction rate in the MD group (41.5%) than in the SMA group (48.3%), even though the curves were smaller in the MD group. The correction in the pelvic obliquity was significantly better in the SMA group (p = 0.03). The predicted vital capacity showed a 4% reduction in the MD group 1 year after surgery, while the SMA group showed a 10% reduction. The peak cough flow and end tidal PCO2 did not deteriorate and were well maintained. The average score for the improvement in self-image satisfaction postoperatively was 3.96 and 4.64 for the MD and SMA groups, respectively. The total complication rate was 45.7%; 14.3% of which were respiratory-related.
Conclusions
Surgical intervention for MD and SMA may be performed safely in patients with a very low forced vital capacity (< 30%) through aggressive preoperative and postoperative rehabilitation efforts.
doi:10.4184/asj.2010.4.2.82
PMCID: PMC2996632  PMID: 21165310
Muscular dystrophy; Spinal muscular atrophy; Neuromuscular scoliosis; Surgical correction; Pulmonary function
13.  The Comparison of Bone Scan and MRI in Osteoporotic Compression Fractures 
Asian Spine Journal  2010;4(2):89-95.
Study Design
Retrospective study.
Purpose
To estimate the usefulness of bone scan and magnetic resonance imaging (MRI) for the diagnosis of new fracture in osteoporotic vertebral fractures.
Overview of Literature
The diagnosis of new fractrure in osteoporotic vertebral fractures requires simple X-ray and supplementary studies.
Methods
We analyzed 87 vertebrae in 44 patients, who diagnosed with osteoporotic vertebral fractures using bone scan and MRI within 2 months interval between August 2001 and July 2008. We compared hot uptakes in bone scan with MRI findings such as new fractures, old fractures and degenerative lesions.
Results
Hot uptakes in bone scan was matched to 48 new fractures, 26 old fractures and 13 degenerative lesions in MRI findings. It was 55% of concordance between hot uptakes in bone scan and new fractures in MRI. The rate of new vertebral fractures confirmed by MRI according to 1 level hot uptakes in bone scan was 96%, 2 levels was 50% and 3 more levels was 36%.
Conclusions
The diagnosis of new fracture in osteoporotic vertebral fractures requires simple X-ray and supplementary studies such as bone scan and MRI. We recommend more careful interpretation in multiple osteoporotic vertebral fracture patients about hot uptake lesions of bone scan.
doi:10.4184/asj.2010.4.2.89
PMCID: PMC2996633  PMID: 21165311
Osteoporotic vertebral fractures; Bone scan; MRI
14.  Changes of Sagittal Spinopelvic Parameters in Normal Koreans with Age over 50 
Asian Spine Journal  2010;4(2):96-101.
Study Design
A prospective comparative study.
Purpose
To describe the changes in the spinopelvic parameters on normal Koreans more than 50 years of age.
Overview of Literature
There are differing opinions regarding the changes in the thoracic kyphosis, lumbar lordosis, C7 plumb with age in the elderly population.
Methods
Sagittal standing radiographs of the whole spine including the pelvis in 132 Korean adult male volunteers more than 50 years of age were evaluated prospectively. Volunteers with a history of spine operation, spinal disease, pain in their back or legs, scoliosis, spondylolisthesis, monosegment disc space narrowing, or compression fracture in radiographs were excluded. The following parameters were included: thoracic kyphosis (T5 upper end plate [UEP]-T12 lower end plate [LEP]), thoracolumbar kyphosis (T10 UEP-L2 LEP), lumbar lordosis (T12 LEP-S1 UEP), lower lumbar lordosis (L4 UEP-S1 UEP), sacral slope, pelvic incidence, and the distances from the C7 plumb to the posterosuperior endplate of S1. These parameters in the 6th, 7th and 8th decade groups were compared and the changes in these parameters according to age were examined.
Results
The thoracic kyphosis demonstrated significant differences in the in the three age groups (p = 0.019), and increased with age (r = 0.239, p < 0.006). The other parameters did not show any significant difference or correlation.
Conclusions
Similar global sagittal balances and spinopelvic parameters may be observed in Korean males older than 50 years, with a trend towards increasing thoracic kyphosis with age.
doi:10.4184/asj.2010.4.2.96
PMCID: PMC2996634  PMID: 21165312
Spine; Pelvis; Aged; Sagittal parameters
15.  Measurement of the Normal Lumbar Intervertebral Disc Space Using Magnetic Resonance Imaging 
Asian Spine Journal  2010;4(1):1-6.
Study Design
This is a retrospective study.
Purpose
We wanted to measure the distance of the normal intervetebral disc space of Koreans.
Overview of the Literature
For judging the distance of the normal intervertebral disc space of Koreans, we studied young adults who didn't have degenerative spinal change to determine the distance of the normal intervertebral disc space of each lumbar vertebral segment, and we did so by performing magnetic resonance imaging (MRI).
Methods
We studied a total of 178 outpatients who had low back pain and they underwent lumbar MRI. There were 138 males and 40 females, and their average age was 20.7 years (range, 15 to 25 years). On MRI, the segments with observed Modic change or other abnormalities were excluded from this investigation. To improvement the accuracy of measurement, two spine specialists measured the distances 2 times, and we calculated the mean value. We used paired t-tests for statistical analysis.
Results
In the total 178 patients, the average distance of intervertebral space from the 1st to the 2nd lumbar vertebrae was 24.83% (range, 18 to 32%), that from the 2nd to the 3rd was 26.92% (range, 19 to 40%), that from the 3rd to 4th was 28.88% (range, 19 to 41%), that from the 4th to 5th was 29.60% (range, 21 to 43%) and that from the 5th lumbar vertebra to the 1st sacrum was 27.52% (range, 19 to 38%).
Conclusions
In this study, we expect that knowing the normal distance of the lumbar intervertebral space of Koreans can be helpful for surgical reconstruction to treat many lumbar spine diseases, to predict the appropriate size of the devices inserted in the intervertebral space and to produce proper devices for Koreans.
doi:10.4184/asj.2010.4.1.1
PMCID: PMC2900163  PMID: 20622948
Lumbar intervertebral disc; Magnetic resonance imaging; Measurement
16.  Comparison of Ultrasonography- and Fluoroscopy-Guided Facet Joint Block in the Lumbar Spine 
Asian Spine Journal  2010;4(1):15-22.
Study Design
Retrospective study.
Purpose
Facet joint block is performed for diagnostic or therapeutic purposes and generally carried out under computerd tomography (CT) or radiologic fluoroscopy guidance. Ultrasonography-guided facet block has recently been attempted. So, we compared the results of ultrasonography-guided facet joint block with the results of fluoroscopy-guided facet joint block.
Overview of Literature
Because fluoroscopic or CT guided facet joint block has been reported side effects, we performed spinal facet block using a fluoroscopy-guided method.
Methods
We selected 133 patients who had lumbar pain or referred pain. They were diagnosed as having spinal stenosis and hospitalized from January 2008 to June 2008. As the subjects, we selected 105 patients who had been follow-up for more than 6 months and carried out a prospective study.
Twenty six subjects were male and 25 were female in the fluoroscopy group (group 1) and their mean age was 56.1 years (range, 45 to 79 years). Twenty one were male and 33 were female in the ultrasonography-guided group (group 2). Their mean age was 58.3 years (range, 47 to 83 years). We studied the average time of the procedures, complications, the difference of the therapeutic cost between the two groups. We also evaluated the visual analogue scale (VAS) score and the Oswestry disability index.
Results
The procedure in group 2 averaged 4 minutes and 25 seconds, and in group 1, 4 minutes and 7 seconds. The coast was an average of 38,000 won in group 2 and 25,000 won in group 1. The VAS score was improved from an average of 7.5 (range, 5 to 9) to 2.8 (range, 2 to 6) in group 2 and from 7.8 (range, 4 to 10) to 2.7 (range, 2 to 5) in group 1. The Oswestry disability index was improved from an average of 32.3 (range, 28 to 41) to 23.5 (range, 17 to 26) in group 2 and from 34.2 (range, 29 to 43) to 24.8 (range, 18 to 28) in group 1. As for complications, worsening of lumbar pain, paresthesia, headache and allergic reaction were detected in 5 cases of group 2 and in 3 of group 1. Those symptoms were improved within several hours. One case of superficial infection that developed in group 2 was improved within several days.
Conclusions
We should consider that ultrasonography-guided facet joint block is a minimal invasive procedure that is easily carried out without radiation exposure.
doi:10.4184/asj.2010.4.1.15
PMCID: PMC2900164  PMID: 20622950
Lumbar pain; Ultrasonography; Facet joint block
17.  An Analysis of the Prognostic Factors Affecing the Clinical Outcomes of Conventional Lumbar Open Discectomy : Clinical and Radiological Prognostic Factors 
Asian Spine Journal  2010;4(1):23-31.
Study Design
This is a retrospective study.
Purpose
We wanted to examine the clinical and radiological prognostic factors affecting the postoperative clinical outcome of patients with lumbar disc herniation and who underwent open discectomy.
Overview of Literature
Conventional open discectomy has been widely used as a treatment regimen for the management of lumbar disc herniation. Still, much controversy exists regarding the factors that affect the postoperative clinical outcomes.
Methods
The current study was conducted on 40 patients who were diagnosed with lumbar disc herniation by the senior surgeon of our department from March 2004 to June 2007. These patients were refractory to conservative treatment and they could be followed up for more than one year following their surgical treatments. Preoperatively, after postoperative year 1 and at the final follow-up, a comparison was made for the Oswestry disability index (ODI) scores and the visual analogue scale (VAS) scores that indicated low back pain and radiating pain. For identifying prognostic factors, an analysis was also performed for such factors as age, gender, the operated level, the duration of preoperative low back pain and radiating pain, a smoking history, the body mass index and whether the surgery was revision or the primary operation. A radiological analysis, based on the preoperative plain flexion-extension radiography, was performed for the presence of mild segmental instability of < 3 mm, spondylolysis and disc space narrowing. Pfirrmann's degenerative grade of the disc, the degree of herniation and whether a herniation was central or massive on the magnetic resonance imaging scans.
Results
At the final follow-up, the ODI was significantly higher in the cases of revision as compared with the cases of primary operation. The female gender also had a tendency for a poor ODI as compared with that of the men, but this had only borderline statistical significance. There was significant correlation between the preoperative ODI and the preoperative VAS indicating radiating pain. At a final follow up, the low back pain VAS score was significantly lower in the extruded cases as compared with that of the protruded or sequestrated cases.
Conclusions
Following an analysis for detecting the prognostic factors of open discectomy, the final clinical outcome was found to be poor for the revision surgery cases. In regard to the type of herniation, the degree of low back pain was relatively lower at a final follow-up for the extruded cases as compared with that for the protruded or sequestrated cases. Open discectomy surgery should be performed after evaluating the patients' various prognostic factors that could affect the final clinical outcome.
doi:10.4184/asj.2010.4.1.23
PMCID: PMC2900165  PMID: 20622951
Lumbar disc herniation; Open discectomy; Clinical outcome; Prognostic factor
18.  The Efficacy of Proximal Lumbar Curve Flexibility in Patients with Main Thoracic Adolescent Idiopathic Scoliosis Treated by Selective Thoracic Fusion Surgery 
Asian Spine Journal  2010;4(1):32-38.
Study Design
Retrospective radiographic study.
Purpose
To evaluate the efficacy of the proximal lumbar curve flexibility compared with the traditional whole lumbar curve flexibility in patients with main thoracic adolescent idiopathic scoliosis (MT-AIS).
Overview of Literature
Traditionally the flexibility of the whole lumbar curve was measured, and the flexibility of the proximal lumbar curve was not analyzed in any study.
Methods
Twenty-eight MT-AIS patients treated by anterior selective thoracic fusion (STF) were evaluated after mean follow-up of 50.1 months (range, 25 to 116 months). The male : female ratio was in 5 : 23. The man age at surgery was 14 years and 8 months (range, 11.4 to 18.4 years). The lumbar curve was divided into the proximal and distal curves by the lumbar apex.
Results
The mean final correction rates (CR)/(flexibilities) of the MT, lumbar, proximal lumbar, and distal lumbar curves were 65.2%/(50.5%), 61.9%/(92.8%), 65.3%/(90.9%), and 36.4%/(134%), respectively. With the final lumbar CR, the lumbar flexibility (r = 0.267, p > 0.05) and the proximal lumbar flexibility (r = 0.327, p > 0.05) was similarly correlated. The mean lumbar CR was similar to the proximal lumbar CR (61.9% vs. 65.3%, p = 0.305). And the correlation between the flexibility and the CR was significant only in the proximal lumbar curve (r = 0.457, p < 0.05), but not in the lumbar curve (r = 0.267, p > 0.05) or the distal lumbar curve (r = 0.175, p > 0.05).
Conclusions
The proximal lumbar curve flexibility may be an alternative method of measuring the lumbar flexibility in MT-AIS patients treated by STF.
doi:10.4184/asj.2010.4.1.32
PMCID: PMC2900166  PMID: 20622952
Adolescent idiopathic scoliosis; Selective thoracic fusion; Lumbar flexibility; Proximal lumbar flexibility
19.  The Trajectory of Iliac Screw in the Axial Plane in 200 Korean Patients 
Asian Spine Journal  2010;4(1):39-43.
Study Design
A retrospective radiographic analysis.
Purpose
To estimate the accurate trajectory in the axial plane for iliac screw insertion in 200 Korean patients using radiographic images.
Overview of Literature
Several complications have been encountered after fusion to the lumbosacral junction, including pseudarthrosis, S1 screw loosening, and sacral fractures. Iliac screw fixation is considered an efficient method for augmenting sacral screw fixation but there are few reports on the trajectory of iliac screw insertion. The trajectory in the sagittal plane can be visualized by intraoperative fluoroscopy. However, there is no method to check the accuracy of the trajectory in the axial plane during surgery.
Methods
Between January 2007 and February 2009, 200 patients (107 men and 93 women) who underwent L-spine computed tomography were enrolled in this study. The mean age of the patients was 55.6 ± 18.3 years (range, 13 to 92 years). The spino-iliac angle (SIA) was measured on the axial image at the S1 level, which was defined as the angle between a vertical line through the center of the spinous process and an oblique line that passed through the center of the outer and inner cortices of the ilium.
Results
The group mean SIA was 30.1° ± 7.8°; 30.1° ± 7.7° for men and 29.9° ± 81.1° for women. There was no significant difference according to gender or age (p > 0.05).
Conclusions
The SIA for the axial trajectory of iliac screws is approximately 30° in Korean patients.
doi:10.4184/asj.2010.4.1.39
PMCID: PMC2900167  PMID: 20622953
Iliac screw; Axial trajectory; Lumbosacral fusion
20.  Treatment for the Lumbosacral Soft Tissue Defect after Spine Surgery 
Asian Spine Journal  2010;4(1):44-47.
The lumbosacral area is one of the most frequently operated spine regions because of the prevalence of disease in that area. Although a lumbosacral soft tissue defect after surgery due to inflammation and other causes is rare, such soft tissue defects are difficult to treat. Therefore, suitable methods for treating lumbosacral soft tissue defects are necessary. Therefore, this study introduces a case-treated with a transverse lumbosacral rotational flap.
doi:10.4184/asj.2010.4.1.44
PMCID: PMC2900168  PMID: 20622954
Lumbar spine; Lumbosacral flap; Soft tissue defect
21.  Primary Thoracic Epidural Melanoma : A Case Report 
Asian Spine Journal  2010;4(1):48-51.
A 68-year-old woman with progressive paraparesis and altered sensation lasting approximately five days was admitted to our clinic. Magnetic resonance imaging (MRI) revealed an advanced stage T7-8 epidural mass ventral to the spinal cord, which was believed to be a metastatic tumor considering the patient's age. A highly enhanced epidural mass and pedicle appeared during the MR scan. However, the pathologic findings were compatible with the diagnosis of a primary meningeal melanocytic tumor. Primary epidural melanomas are extremely rare lesions. This case was finally diagnosed as a primary thoracic spinal epidural melanoma.
doi:10.4184/asj.2010.4.1.48
PMCID: PMC2900169  PMID: 20622955
Central nervous system; Primary spinal melanoma; Thoracic lesion
22.  Thoracic Disc Herniation of the Adjacent Segment With Acutely Progressing Myelopathy 
Asian Spine Journal  2010;4(1):52-56.
We report a case of a 66-year-old woman with progressing myelopathy. Her history revealed instrumented fusion from T10 to S1 for degenerative lumbar kyphosis and spinal stenosis. The plain radiographs showed narrowing of the intervertebral disc space with a gas shadow and sclerotic end-plate changes at T9-T10. Magnetic resonance imaging revealed a posterolateral mass compressing the spinal cord at the T9-T10 level. The patient was treated with a discectomy through the posterior approach combined with posterior instrumentation. The patient's symptoms and myelopathy resolved completely after the discectomy and instrumented fusion. The thoracic disc herniation might have been caused by the increased motion and stress concentration at the adjacent segment.
doi:10.4184/asj.2010.4.1.52
PMCID: PMC2900170  PMID: 20622956
Adjacent; Thoracic; Disc herniation; Paraplegia
23.  The Pathogenesis and Medical Treatment of Spondylogenic Pain 
Asian Spine Journal  2010;4(1):57-63.
Pain is perceived and then it is operated on in the cerebral cortex by several processes such as transduction, transmission, modulation and perception. We have to know the exact mechanism of pain. The purpose of this review is to explain the mechanisms of pain and to discuss the definitions of the terms related to pain. We also review the mechanisms of the analgesic effect of the pharmaceuticals we use to control pain.
doi:10.4184/asj.2010.4.1.57
PMCID: PMC2900171  PMID: 20622957
Spondylogenic pain; Pathogenesis; Treatment
24.  Notice of duplicate publication 
Asian Spine Journal  2010;4(1):64.
doi:10.4184/asj.2010.4.1.64
PMCID: PMC2900172  PMID: 20622958
25.  Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis 
Asian Spine Journal  2010;4(1):7-14.
Study Design
This study is a prospective, clinical study for lumbar degenerative kyphosis.
Purpose
To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis.
Overview of Literature
Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results.
Methods
This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes).
Results
Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 ± 2.79 in group A and 26.44 ± 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 ± 3.3° in group A and 11.72 ± 1.89° in group B.
Conclusions
There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.
doi:10.4184/asj.2010.4.1.7
PMCID: PMC2900173  PMID: 20622949
Lumbar degenerative kyphosis; Dynamic pelvic tilt; Radiological assessment; BMI and clinical outcomes

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